ClassProposalForm

Fall2016

UNT Lifelong Learning and Professional Development

UniversityofNorthTexas ◊ 1155UnionCircle#310560◊ Denton,TX76203-5017

◊ Phone:940-565-3487◊ Fax:940-565-3801

Please return this form to Dr. Marilyn Wagner by June 1, 2016

PLEASE READ THE INSTRUCTIONS BEFORE YOU BEGIN: Please fill-in, check, or “choose one”in theempty grey boxes below with the appropriate information, as instructed in bold beforehand. YOU MUST FILL IN EVERY GREY BOX (N/A, None, and other substitutions are acceptable). There are two sections: Personal Information (page 1) and Class Information (page 2).

Personal Information

Emeritus College instructors stay connected primarily through email. Please provide an email address that you check regularly. Other information is used solely by our Emeritus College staff for other communication purposes.

Your Name

Preferred title (please choose one) Mr. Mrs. Ms. Dr. Other______

Areas of Interest

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone

Class Information

In order for us to create an accurate class schedule, please be as specific as you can about what location, month, day, and time you want to instruct. If you have any additional questions or concerns about your class details, please contact Madelynn Camp (940-565-4752 or ).

Class Title

Class Format

Each class session is 60-90 minutes long.

UNT Union (Room 382) Class Times:

Mon/Wed 10:00am-11:30am or 11:45am-1:15pm

Robson Ranch (Main Clubhouse) Class Times:

Tues/Thurs 10:00am-11:30pm, 1:00pm-2:30pm, or 2:45pm-4:15pm

  • Location
  • Number of Sessions
  • Preferred Month (You can choose more than one.)

September October

  • Preferred day of the week(You can choose more than one.)

MondayTuesdayWednesday Thursday

  • Preferred time of day(You can choose more than one.)

UNT Times: 10:00am-11:30am11:45am-1:15pm

Robson Ranch Times:10:00am-11:30am1:00pm-2:30pm 2:45pm-4:15pm

Class Description (800 character limit)

Instructor Biography (800 character limit)

Emeritus College, in an effort to be eco-friendly, posts your handout/reference material on our website, allowing members to print the documents before the classes they are attending.

Will you provide handouts/reference materials for this particular class?

Will you need any equipment (Computer, projector, DVD, CD, other), and if so, what kind?

Enrollment limit?

Please specify any other special arrangements for your class (100 character limit)